Counting down to ObamaCare: What's coming in 2013?

Most Americans still don't know what to expect from President Obama's health care overhaul, and the big changes are yet to come By Peter Weber | 7:30am EST

When House Speaker John Boehner (R-Ohio) said after the 2012 election that "ObamaCare is the law of the land," he was more stating the facts than waving a white flag. Republicans haven't entirely given up on neutering, or at least undermining, President Obama's signature domestic achievement, but the Patient Protection and Affordable Care Act has survived several legislative attempts at repeal, a harrowing Supreme Court challenge, and now a presidential election that promised critics their last best chance of killing ObamaCare before it takes full effect in 2014. Still, a lot of the nuts and bolts of the law are still loose (or still in their packaging), making 2013 a very big year for the health care overhaul. Here's a chronological rundown of what benefits and rules kick in over the next year, what has yet to be finalized, and what the GOP is doing to keep up the fight:

What has already taken effect

As Obama noted repeatedly in the presidential campaign, ObamaCare already allows parents to keep their children on their health insurance plans until age 26, makes it so children cannot be denied coverage due to pre-existing conditions, offers some preventative services at no out-of-pocket cost, and prohibits insurers from setting lifetime limits on benefits. On Nov. 20, the Department of Health and Human Services (HHS) published a whole ream of (largely technical) rules guiding how ObamaCare will be implemented.

December 14, 2012

This is the HHS deadline for states to decide whether they will set up their own health insurance exchanges, partner with the federal government, or let the feds set one up for them. "Basically, these will be health insurance stores," says Peter Grier at The Christian Science Monitor, "markets intended to provide a more organized and competitive way for people to buy a product that's often complicated and confusing." Eligible shoppers will include workers whose employers don't provide affordable health care, the self-employed, and early (pre-Medicare-age) retirees.

As of Nov. 29, 18 states have said they will set up their own exchanges, six have signed on for state-federal partnerships, 17 said they will leave the work to the federal government, and 10 are still undecided. Massachusetts and Utah already have exchanges, although Utah's is "relatively barebones" and only serves employers, not individuals, says Sarah Kliff at The Washington Post.

1. Unfortunately, for a lot of people they have to wait until 2014 to get coverage. That is a long

2. California: Please resurrect the single-payer effort!

Now that Jerry Brown is in office one might think it would pass, but it's going to be a long haul:

Why Did Single-Payer Health Care Fail in California?

By Lenny Potash
Labor Notes, Feb. 17, 2012

Though itís passed the legislature twice before, a bill to establish a single-payer universal health insurance system in California failed in the state senate in January. Not surprisingly, the bill received no Republican votes, but it fell just two votes short of passage when two Democrats voted no and four Democrats failed to vote, despite intense lobbying efforts by community and some labor health care activists.

Angry activists pointed to the fact that five of the six errant Democrats had received money from the insurance industry and Big Pharma, ranging from $100,000 to over $250,000. Three of the six senators had been endorsed by the California Labor Federation which, along with unions such as the Service Employees and AFSCME, was on record supporting the single-payer bill. The California Democratic Party was also on record supporting it. Similar bills passed the legislature fairly easily in 2006 and 2008, only to be vetoed by then-Governor Arnold Schwarzenegger. At a time when premiums were rising and there were few other proposals out there, it was an easy vote for Democrats certain of the governorís veto.

But when Congress passed federal health reform in 2010, defending that bill, as well as President Obama, became paramount for many Democrats. It became more difficult for legislators to vote for a single-payer bill that might be interpreted as deserting the president, and the Democratic leadership refused to put the bill up for a final vote in the Assembly.

In 2011-12 the issue in some ways became even more loaded, with a Democratic governor facing massive budget deficits. Even though single payer would save Californians much more money in the medium term by reducing the huge overhead costs of insurance and drug companies, Governor Jerry Brown did not express support for the measure, and some Democrats feared to be seen backing an expensive bill.